Suicide rates among children ages 10–16 has increased 70% in California in the last 10 years. This indicates tragically that something in the environment has changed dramatically, what could it be?
Students who are suicidal enter a school psychologist’s office in a variety of ways. A friend may make a referral after seeing a text or a post that worried them, a teacher finds a note, a student may calmly walk in your office and ask for help, or during a fight or flight rage someone may admit suicidal thoughts. However students who are at risk make it to my office, the protocol doesn’t vary. In addition to listening, empathizing, and building trust, a suicide risk assessment is conducted asking a series of specific questions. Most importantly: Do they have intent? Do they have a plan? Can they act on the plan? Can they contract to safety? The priority is to ensure a child is safe, knows they are cared for, and they have support.
I was in my fifth year as a middle school psychologist in the Bay Area when something shifted. It was common to do 2 dozen suicide risk assessments at a large middle school in the course of a school year. This was despite a robust mental health team with 7 therapists from different agencies who worked at the school and a wide array of support services and enrichment activities. About once a month this risk assessment would result in a hospitalization. In 2014–2015, the rate increased dramatically with 2 or 3 hospitalizations often occurring a month. A public health official from the city at that time came to check in. ‘We’ve noticed you have been calling in more 5150s (a code for referral to a psychiatric hold related to threat to harm self or others), we want to know what is happening.’ I responded, ‘I’ve noticed that too, I haven’t changed my criteria but the need is greater.’ To my relief they wanted to figure out how to address this, ‘What do you think could be going on?’
My criteria hadn’t changed but one of the responses had. In addition to questions about intent, access, and safety, I also ask ‘Who do you go to when you need help?’ Students usually have a pretty clear plan of who they can talk to. Generally a mix of friends, teachers, parents, extended family and community members. Now the response was ‘Every time I tried to talk to them they are on their phone.’ ‘My parents are too busy on Facebook.’ ‘My mom gets mad if I interrupt candy crush.’
The saturation of smartphones in society had begun. We now know just how addictive smart phones can be and the dangers associated. What are some problems with rapid changes in technology? Unintended consequences. Distracted driving, addiction, cortisol increase, and quite possibly a skyrocketing teen suicide rate. The state of California recently released a report on adolescent mental health and clearly identified the impact of smartphone use on a child’s wellbeing.
Maria’s attempt came out of the blue that year*, no signs of mental health difficulties, no previous referrals, no requests from parents for assistance. One day she told her parents she didn’t want to do her homework and then went in the bathroom and took some pills. Fortunately she was rushed to the hospital and survived. Maria was hospitalized on a psychiatric hold for several days. Upon release one of the elements of the safety plan was to reduce time she spent on the phone. I was asked to do the psycho-educational evaluation. I went to the home to work with Maria who had opted for home instruction. While I sat in the kitchen and completed a screening, her mom sat on one sofa glued to her phone and dad sat on another glued to his phone. The smartphone addiction had encompassed parents before we knew what hit us. It wasn’t the child’s addiction that was disrupting their relationships, it was ours.
Dopamine and Oxytocin are two types of neurotransmitters we receive from relationships. They both make us feel great and impact our behavior. Oxytocin can come from affectionate connections with others. Dopamine on the other hand is released from stimulation: gambling, exercise, drugs, food, and playing with your phone. It is highly addictive but it can’t replace Oxytocin for the way it mitigates the effects of cortisol. We suddenly had a bunch of kids who were getting more dopamine from their relationships and way less oxytocin. Way less time feeling heard and way more stimulation and addiction. The result is a constant feeling of being stressed out with a dramatically undermined avenue for coping. We have all seen how our relationships are impacted by the smartphone. Do you roll over and look at your partner in the eyes when you wake up or do you nod as you both stare down at screens? How many young parents have you seen on the phone as an infant lies babbling in their stroller seeking interaction? How do you feel when someone places a cell phone on the table during dinner? Does face down really make you feel better?
There is no judgement in this comment, no individual blame for what has occurred. How can we respond so quickly to such rapid changes when we don’t even know it is about to happen until it is already upon us? The fact is we are losing more teenagers to suicide than we were a decade before and this is a tragedy for society. Through the individual heartbreak of families and loved ones and the loss of a valuable member of our community, suicide affects us all. If changes are happening faster, we need to respond faster.
Despite all the evidence that using smartphones around your child was a bad thing to do, I still couldn’t stop getting glued to the smartphone around my daughter. Everything felt so urgent, so important, so stimulating. We tried to make screen free rooms but I broke that rule. It now requires significant effort on my part to stay away from my phone around my child. It has been such a struggle that I considered buying a small lock box, putting my phone in it, giving her the key and asking for permission if I needed to make a phone call. And I love my daughter more than ANYTHING in the world! She is fabulous and fun and a complete joy to be around. We see it time and time again in drug addiction, dopamine can override dedication and powerful love for others.
Turns out I don’t need a box with a key, Apple has come out with a new feature for the iPhone that allows you to do that virtually. Just set a time for your phone to require a passcode for certain apps.
This is a new feature available on ios 12 or higher, to find it go to Settings> Screen Time.
Then set your downtime limits to the time that you think is the most important time you spend with your child. If they are young is it bedtime? Does it apply to weekdays and weekends? Older children may be able to tell you what time is best for them. I changed mine to our family time 5pm-8pm when we are all home from activities and having dinner.
Next go back to Screen Time, scroll down to ‘Use Screen Time Passcode’ and without looking have your child create a code (and write it down).
Only your child (and a trusted adult if necessary) knows the code. If you do need to access an app during downtime, you will need to have a conversation with them as to why you need it, which makes you stop and think. Makes us prioritize being there most of all. Who knows what our adolescents are experiencing in their lives online or away from home, this is one extra step to making sure we don’t miss opportunities for connection.
Psychiatrist Bessel Van Der Kolk describes trauma as ‘overwhelming, unbearable, and unbelievable.’ This definition means what is traumatic varies person to person and it is difficult to predict what will overwhelm another person’s coping strategies. One way a child builds coping strategies is through co-regulation, this is the process of calibrating emotions with another person who models coping strategies. Think of looking at a baby’s face and making expressions or the way we react when a child comes to us crying. These moments when we mirror how someone is feeling, validate feelings and build skills for managing stress, fear, and anxiety. On a large scale, schools are noticing there is a crisis in disruption, an elevated level of disregulated behaviors in the classroom. This puts the responsibility for co-regulation on the teacher. As parents, we do a lot of modeling intuitively and we are responsive to subtle behavioral cues. What if we have become too distracted to pick up on those subtle cues and opportunities for co-regulation are lost? Dr. Bruce Perry, child psychologist, observed that certain children in his clinical practice responded better to therapy. When he examined all the variables to find a common factor driving resilience, he found that the children who lived further away from the clinic had better outcomes. The more they looked at this the more they realized, it wasn’t necessarily their techniques but the undivided attention of a caregiver during a long car trip that was improving a child’s outcomes.
We work really hard to protect our children, we have to make sure we will be there for them when they need us. Sometimes we just have to own the fact that it isn’t our kids that are the ones that need to change, it’s us.
*Information has been changed to maintain confidentiality